Comparison of functional outcomes of dynamic hip screw and proximal femoral nail in elderly patients presenting with intertrochanteric femur fracture.

Abstract

Objective: To evaluate and compare the functional outcomes and perioperative metrics of Dynamic Hip Screw (DHS) and Proximal Femoral Nail (PFN) fixation in elderly individuals with intertrochanteric femoral fractures. Study Design: Prospective, Observational Comparative study. Setting: Department of Orthopaedic, Ziauddin Hospital, Karachi. Period: August 2022 and February 2023. Methods: One hundred patients aged 60 years or older with OTA/AO type 31-A1 and 31-A2 intertrochanteric fractures were enrolled and divided equally into DHS and PFN groups. Patients with pathological fractures, high-energy trauma, or severe cognitive impairment were excluded. Surgeries were performed within 72 hours using standardized operative protocols. The primary endpoint was functional recovery at 6 months, assessed using the Harris Hip Score (HHS). Secondary variables included intraoperative parameters, hospital stay duration, time to mobilization, fracture healing time, and postoperative complications. Results: The PFN group demonstrated a shorter operative time, reduced blood loss, and earlier mobilization (p<0.001). Mean HHS at 6 months was significantly higher in the PFN cohort (85.8 ± 6.6) compared to DHS (80.9 ± 6.9, p<0.001). Excellent outcomes were more frequent in PFN (32%) than DHS (12%). Screw cut-out was seen only in the DHS group (10%, p = 0.022). Conclusion: PFN fixation provides superior early functional results and fewer mechanical complications compared to DHS in elderly patients with intertrochanteric fractures.